Daycare, Camps, and Recreational Programs: State Laws and Regulations

Even though federal laws provide protection for children with disabilities, state law often impacts whether non-nursing staff at a daycare or other programs can provide insulin injections and emergency glucagon injections. These provisions take the form of laws, regulations, or state Board of Nursing policies or guidelines and enable staff at daycare and other programs to meet the needs of children with diabetes. Parents and other advocates can use this information to educate a daycare, camp, or other organization about how the organization can ensure that a child with diabetes can safely and equally enjoy the program.

Every state has laws that affect who can provide diabetes care, but only those laws that specifically authorize or require an entity to provide medication or services are listed here. Sometimes the law is difficult to interpret.

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Legislation, regulations, or nursing policies in the states listed below address who at a daycare, camp, or other program may administer diabetes care.

If your state is not listed here, it means that your state has not passed laws that specifically authorize or require an entity to provide medication or services related to diabetes.

Applies to child care facilities and states that in an emergency, staff at a child care facility may give an injection to a child according to Arizona Statutes § 32-1421(A)(1) and § 32-1631(2). This can apply to severe low blood glucose emergencies and glucagon.

States that nursing rules limiting who can provide nursing services do not apply to a person responding to an emergency. This means that a person who administers glucagon to a child experiencing severe low blood sugar is not violating nursing rules.

A child care facility "exception" is a written authorization issued by the California Department of Social Services to allow the child care facility to use alternative means which meet the intent of a specific regulation and that are based on the unique needs or circumstances of a specific child or staff person.

The California Department of Social Services has the ability to grant exceptions to child care facilities so that the facility can use alternate concepts, programs, services, procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conduct of experimental or demonstration projects, in order to provide safe and adequate services. This can include exceptions to allow child care staff to administer glucagon or, potentially, insulin via an insulin pump.

Nurses may train and allow unlicensed child care staff to administer injections of insulin or glucagon.

If a child is capable of self-administering, a nurse may train and allow unlicensed child care staff to verify insulin dosages via pump or pen.

An individualized health plan (IHP) will be developed for any child receiving insulin at the child care facility describing the diabetes care the child care staff will provide, and child care staff will follow the IHP when providing diabetes care. The IHP may include, for example:

If a child with diabetes is enrolled in a child care center or day care organization, the organization shall train staff to provide finger stick blood glucose tests and ensure that trained staff are available to do so when the child is present.

The child care center or day care organization shall keep a written plan on file, which will include: a list of trained staff, a written doctor’s order, an authorization form, any diet restrictions, and other information. See full regulation for required list of information to be included in the written plan.

Any person who, without payment and in good faith, gives emergency care or treatment in any place with proper equipment (such as administering glucagon) shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act so long as the person acts as an ordinary reasonably prudent person would have acted under the circumstances.

Rules regarding nursing care do not prohibit individuals from providing nursing care in an emergency, such as administering glucagon in an emergency.

Rules regarding nursing care do not prohibit individuals from performing health tasks such as insulin administration and glucagon administration if they have been trained and given authorization to do so by a health care professional, such as a nurse.

Any person who in good faith renders emergency care (such as administering glucagon) without compensation shall not be liable for any civil damages unless the care is reckless or involves willful and wanton misconduct.

Any person who gives emergency treatment or rescue assistance to a person who is unconscious, ill, injured or in need of rescue assistance, shall not be liable for damages, unless they result from intentional, wanton, or reckless behavior, or by gross negligence.

Rules regarding nursing care do not forbid nurses from training and allowing a lay person to perform nursing tasks so long as they do not become a routine part of the lay person’s job (emergency glucagon fits this requirement).

Any person who has been trained to provide first aid may give emergency care according to the training and shall not be liable for damages except for those caused by gross negligence, or willful or wanton acts.

Staff or operators of a child care facility may administer medication by a route other than inhalation, oral, into the eyes, ears, or nose, or topical (such as insulin and glucagon injections) when a caretaker or licensed health care professional has written that the child care staffperson or operator is competent to administer the medication and a licensed health care professional has stated in writing that this can safely be done for the particular child.

Any person who renders emergency care or assistance in an emergency (such as glucagon administration), without payment and in good faith, is not liable for any civil damages unless the person acts with gross negligence.

Child care programs shall allow children to carry insulin and keep it in their possession while at the program so long as the child’s health care practitioner has given written authorization and the parents give written consent.

Child care centers will provide reasonable accommodations, including administering medication or performing health care procedures to a child with special needs, if failing to administer the medication or procedure would endanger the health of the child or prevent the child from attending.

The parent must provide written consent for the center to administer medication, and a written statement from the child’s health care provider with instructions.

Before administering a health care procedure, such as administering a blood glucose test, the center shall ensure that the staff who will perform the blood glucose test have been trained by the child’s parent or another appropriate person.

A daycare provider may not administer medication by injection except for a child with special health care needs (such as diabetes), where the parent, day care provider and the child's health care provider have agreed on a plan pursuant to which the provider may administer medications by injection (such as insulin and glucagon).

Rules regarding who may perform nursing care do not forbid a person authorized by a physician or nurse from performing patient-care services which are routine, repetitive, limited in scope and do not require the professional judgment of a nurse (such as blood glucose testing and insulin administration).

Rules regarding who may perform nursing care do not forbid any person from assisting in the event of an emergency (such as administering glucagon due to severe hypoglycemia).

Any person who provides aid or assistance in an emergency (such as administering glucagon due to severe hypoglycemia) cannot be found liable for practicing medicine or nursing without a license.

Any person who provides aid or assistance in an emergency cannot be sued for personal injury related to the emergency aid or assistance, and cannot be found liable, unless the person acted with intentional misconduct or gross negligence.

Any person who provides aid or assistance in an emergency (such as administering glucagon due to severe hypoglycemia) cannot be found liable for injury resulting from the aid or assistance unless the person acted with gross negligence.

Child care regulations require that parents provide written authorization in order for a child care provider to provide emergency medical treatment for the child (such as glucagon) and administer medication (such as insulin) to the child.

A child day care must make reasonable accommodations to facilitate administration of medication or a special diet for a child with special needs as required by federal and state disability laws (including children with diabetes who require insulin and emergency glucagon).

A child day care staff person who has completed and passed a medications administration course and who has completed and passed a diabetes patient education program within the past 12 months that meets the Standards for Diabetes Patient Education Programs of the Pennsylvania Department of Health is permitted to administer insulin injections.

Any person who has a current certificate of training in first aid (given by the American Red Cross, the American Heart Association, or approved by the Pennsylvania Department of Health) who renders emergency care, first aid or rescue at the scene of an emergency (such as administering glucagon) shall not be liable for any civil damages related to the emergency care, unless the person intentionally causes harm or acts with gross negligence.

Any person who provides emergency assistance (such as administering emergency glucagon) cannot be found liable for civil damages for providing the emergency care, unless the person is grossly negligent or engaged in willful or wanton conduct.

Any person who provides emergency care (such as administering glucagon) shall not be liable for any civil damages resulting from the emergency care, except damages from gross negligence or wilful or wanton misconduct.

Any person who provides emergency care in good faith (such as administering glucagon) without making any direct charge for the emergency care shall not be liability for civil damages except damages caused by the person’s gross negligence.

According to nursing rules regarding who can legally administer medication, a non-nurse may take any action that a reasonable, prudent non-health care professional would take in an emergency situation (such as administering glucagon).

A nurse may train and allow a non-nurse to perform tasks that can be properly and safely performed by the non-nurse (such as a daycare staff person testing blood glucose, counting carbohydrates, treating low blood glucose with a snack, or administering insulin according to doctor's orders).

If a child with diabetes is enrolled in a Child Day Care Program, there must be someone on staff and physically present in the facility that has received the Medication Administration Training Certification (8-hour program) and training to administer insulin and for emergency administration of glucagon.

If a child who has been prescribed a medication such as glucagon (should also include insulin per Virginia Board of Nursing Guidelines, above) is enrolled at a daycare, the daycare must have staff trained to administer that medication present at all times that the child attends the program.

This staff person or independent contractor must have completed a training program in glucagon and insulin administration approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor, or pharmacist; or administration shall be performed by a staff member or independent contractor who is licensed by the Commonwealth of Virginia to administer medications.